儿童克罗恩病营养状况与临床特征及危险因素分析

Clinical characteristics and nutritional status of children with Crohn's disease and risk factors for malnutrition

摘要:

目的 探讨儿童克罗恩病（Crohn's disease, CD）诊断时的营养状态，并分析其与临床特征的关系。方法 回顾性分析2016年1月—2024年1月首都医科大学附属北京儿童医院收治的118例CD患儿的临床资料及营养状态，采用多因素logistic回归分析探讨营养不良发生的危险因素。结果 共纳入CD患儿118例，男68例（57.6%），女50例（42.4%），平均年龄（11±4）岁。临床症状以反复腹痛（73.7%，87/118）、腹泻（37.3%，44/118）及便血（32.2%，38/118）等为主，63.6%（75/118）患儿诊断时有体重下降。营养不良发生率为63.6%（75/118），其中中重度营养不良占67%（50/75）。营养不良分型显示消瘦50例（42.4%），生长迟缓8例（6.8%），超重及肥胖9例（7.6%）。营养指标检测显示血清白蛋白降低83例（70.3%），贫血74例（62.7%），25羟基维生素D下降15例（60%，15/25）。营养状况与临床特征分析显示营养不良患儿的中重度活动比例、肠狭窄比例、红细胞沉降率明显升高，血清白蛋白值显著降低（P<0.05）。多因素logistic分析显示肠狭窄是CD患儿营养不良的独立危险因素（OR=4.416，P<0.05）。结论 儿童CD诊断时营养不良发生率高，与疾病活动度、疾病行为有关，应密切监测CD患儿的营养状态，早期识别干预。

Abstract:

Objective To investigate the nutritional status of children with Crohn's Disease (CD) at diagnosis and its association with clinical characteristics.Methods A retrospective analysis was performed for the clinical data and nutritional status of 118 children with CD who were admitted to Beijing Children's Hospital, Capital Medical University, from January 2016 to January 2024. A multivariate logistic regression analysis was used to investigate the risk factors for malnutrition.Results A total of 118 children with CD were included, among whom there were 68 boys (57.6%) and 50 girls (42.4%), with a mean age of (11±4) years. Clinical symptoms mainly included recurrent abdominal pain (73.7%, 87/118), diarrhea (37.3%, 44/118), and hematochezia (32.2%, 38/118), and 63.6% (75/118) of the children had weight loss at diagnosis. The incidence rate of malnutrition was 63.6% (75/118), and the children with moderate or severe malnutrition accounted for 67% (50/75). There were 50 children (42.4%) with emaciation, 8 (6.8%) with growth retardation, and 9 (7.6%) with overweight or obesity. Measurement of nutritional indices showed a reduction in serum albumin in 83 children (70.3%), anemia in 74 children (62.7%), and a reduction in 25 hydroxyvitamin D in 15 children (60%, 15/25). The children with malnutrition had significantly higher disease activity, proportion of children with intestinal stenosis, and erythrocyte sedimentation rate and a significant reduction in serum albumin (P<0.05). The multivariate logistic regression analysis showed that intestinal stenosis was an independent risk factor for malnutrition in children with CD (OR=4.416, P<0.05).Conclusions There is a high incidence rate of malnutrition in children with CD at diagnosis, which is associated with disease activity and disease behavior. The nutritional status of children with CD should be closely monitored.